Moral distress and intention to leave: A comparison of adult and paediatric nurses by hospital setting

Objectives: To assess moral distress intensity and frequency in adult/paediatric nurses in critical care and non-critical care units; and explore relationships of nurse characteristics and moral distress with intention to leave. Methods/setting: A descriptive, correlational design was used to administer an online survey using the Moral Distress Scale to nurses across multiple settings. Main outcome measures: Intensity and frequency of moral distress and intention to leave current position. Results: The survey response rate was 43% (n = 426/1000). Critical care nurses had the highest levels of moral distress intensity and frequency, compared to non-critical care specialties (M = 2.5 +/- 0.19, p = 0.005 for intensity and M = 1.6 +/- 0.11, p < 0.001 for frequency). Moral distress frequency showed a positive relationship with intention to leave a position of employment. Each unit increase in moral distress frequency doubled the odds of intention to leave when adjusting for age, gender, ethnicity and specialty area (p = 0.003). Hispanic nurses had significantly higher levels of moral distress intensity (p = 0.01). Conclusion: Moral distress is a complex phenomenon requiring further study, particularly with regard to the role of ethnic and cultural differences on perceptions of moral distress. (C) 2016 Elsevier Ltd. All rights reserved. Implications for Clinical Practice No significant difference in moral distress intensity and frequency was noted when comparing nurses by age, education or years of experience. However, all nurses regardless of their professional preparation are at risk for moral distress. Hispanic nurses reported significantly higher levels of moral distress, suggesting that culture and ethnicity may play a role in the perception and experience of moral distress. Ongoing support of nurses in high acuity settings where morally distressing situations occur is vital to, creating a healthy work environment.